腹腔镜完整结肠系膜切除术治疗Ⅲ期右半结肠癌的疗效评价  

Efficiency evaluation of laparoscopic complete mesocolic excision in the treatment of stage Ⅲ right colon cancer

作　　者：兰晓军 姚晖 王明明 徐亮 LAN Xiao-jun;YAO Hui;WANG Ming-ming;et al(Department of Gastrointestinal Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, Chin)

机构地区：[1]西南医科大学附属医院,四川泸州646000

出　　处：《腹腔镜外科杂志》2018年第3期165-169,共5页Journal of Laparoscopic Surgery

基　　金：卫生行业科研专项资助项目(编号:201302016)

摘　　要：目的:探讨腹腔镜完整结肠系膜切除术(complete mesocolic excision,CME)治疗Ⅲ期右半结肠癌的临床疗效。方法:回顾分析2012年1月至2014年6月手术治疗的122例Ⅲ期右半结肠癌患者的临床资料,分为腹腔镜组(n=55,行腹腔镜CME)与开腹组(n=67,行开腹CME)。对比分析两组患者手术相关指标、近远期预后情况。结果:腹腔镜组手术时间长于开腹组(P<0.001),术中出血量、切口长度、住院时间优于开腹组(P<0.05);两组淋巴结清扫数量[(22.1±5.2)枚vs.(19.0±4.4)枚]差异无统计学意义(P>0.05),两组阳性淋巴结检出数量[(4.2±1.5)枚vs.(2.6±1.3)枚]差异有统计学意义(P<0.05);两组术后并发症发生率、术后排气时间、进食时间差异无统计学意义(P>0.05)。术后1个月,两组CEA、CA19-9水平较术前降低(P<0.05),但组间差异无统计学意义(P>0.05);腹腔镜组3年复发率、转移率、总体生存率分别为10.9%、9.1%与80.0%,开腹组为13.4%、9.0%与77.6%,两组差异无统计学意义(P>0.05)。结论:Ⅲ期右半结肠癌行腹腔镜CME不增加手术风险及并发症发生率,具有创伤小、安全可行、手术视野与解剖层次清晰、术后康复快等优势,近、远期疗效与开腹手术相当。Objective： To investigate clinical outcomes of laparoscopic complete mesocolic excision in stage Ⅲ right colon cancer. Methods： Clinical data of 122 patients who suffered from stage Ⅲ right colon cancer and underwent surgery between Jan. 2012 and Jun. 2014 were retrospectively analyzed. Laparoscopic surgery was performed in 55 patients,and open surgery in 67 patients. Indicators related to the operation,and short-and long-term outcomes were compared between the two groups. Results： The operation time in laparoscopic group was more than that in open group（ P 〈0. 001）. However,there was less intra-operative bleeding,shorter incision lengths and hospital stay in the laparoscopic group（ P 〈0. 05）. The average number of lymph nodes dissected between laparoscopic（ 22. 1 ±5. 2） and open surgery（ 19. 0 ± 4. 4） was not significantly different（ P 〉0. 05）. However,the number of positive lymph nodes in laparoscopic group（ 4. 2 ± 1. 5） was more than that in open group（ 2. 6 ± 1. 3,P 〈0. 05）. The overall complication rate,postoperative exhaust and eating time did not differ between groups（ P〉 0. 05）. CEA and CA19-9 concentrations in both groups decreased significantly one month after the operation（ P 0. 05）,but there was not significant difference between the two groups（ P 〉0. 05）. For laparoscopic surgery,the three-year recurrence rate was 10. 9%,metastasis rate was 9. 1% and overall survival rate 80. 0%. For open surgery,the rates were 13. 4%,9. 0% and 77. 6%,respectively. Three-year prognosis did not differ between groups（ P 〉0. 05）. Conclusions： Laparoscopic complete mesocolic excision for treatment of stage Ⅲ right colon cancer does not increase the risk of surgery or the incidence of complications. The overall outcome of laparoscopic procedure is comparable to open surgery but with advantages of fewer trauma,safety,clear operation vision and anatomy plane,and quick postoperative recovery.

关 键 词：结肠肿瘤 腹腔镜检查 完整结肠系膜切除术 治疗结果 

分 类 号：R735.35[医药卫生—肿瘤]